Sessions Of Behavioral Therapy Research Articles

Change in Defense Mechanisms and Depression in a Pilot Study of Antidepressive Medications Plus 20 Sessions of Psychotherapy for Recurrent Major Depression.

Treatment studies of major depression commonly focus on symptoms, leaving aside change in putative psychological risk factors. This pilot study examines the relationship between changes in eight depressive defenses and depressive symptoms. Twelve adults with acute recurrent major depression were given antidepressive medications and randomized to 20 sessions of either cognitive behavioral therapy or dynamic psychotherapy and followed for 1 year. Defenses were assessed using the Defense Mechanism Rating Scales (DMRS) and Defense Style Questionnaire (DSQ) at intake, termination, and 1-year follow-up. Depression improved highly significantly on both the Hamilton Rating Scale for Depression and Beck Depression Inventory, respectively, eight (67%) and nine (75%) patients attained recovery by 1 year. Depressive defenses improved significantly by termination (mean ES = 0.97; 95% confidence interval, 0.30-2.16), but retrogressed somewhat by 1 year. A mean of 12.17% (SD = 10.60) depressive defenses remained; only five subjects (50%) attained normative levels. Although causal relationships were not established, depressive defenses are promising candidates for mediating treatment effects on outcome of major depression.

The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/ or self-destructive behaviour (DIASS): study protocol for a multicentre randomised controlled trial

BackgroundMany persons with autism spectrum disorder (ASD) are treated in long-term specialised care. In this population, suicidal behaviour troubles patients, families, and specialists in the field because it is difficult to treat. At present, there is no documented effective therapy for suicidal behaviour in ASD (Autism Research 7:507-521, 2014; Crisis 35:301-309, 2014). Dialectical Behaviour Therapy (DBT) is an efficacious treatment programme for chronically suicidal and/or self-harm behaviour in patients with Borderline Personality Disorder (J Psychiatry 166:1365-1374, 2014; Linehan MM. Cognitive behavioural therapy of borderline personality disorder. 1993). This study will evaluate the efficacy of DBT in persons with ASD and suicidal/ self- destructive behaviour in a multicentre randomised controlled clinical trial.MethodOne hundred twenty-eight persons with autism and suicidal and/or self-harming behaviour will be recruited from specialised mental healthcare services and randomised into two conditions: 1) the DBT condition in which the participants have weekly individual cognitive behavioural therapy sessions and a 2.5 h skills training group session twice per week during 6 months, and 2) the treatment as usual condition which consists of weekly individual therapy sessions of 30–45 min with a psychotherapist or social worker. Assessments will take place at baseline, at post-treatment (6 months), and after a follow-up period of 12 months. The mediators will also be assessed at 3 months. The primary outcome is the level of suicidal ideation and behaviour. The secondary outcomes are anxiety and social performance, depression, core symptoms of ASD, quality of life, and cost-utility. Emotion regulation and therapeutic alliance are hypothesised to mediate the effects on the primary outcome.DiscussionThe results from this study will provide an evaluation of the efficacy of DBT treatment in persons with ASD on suicidal and self-harming behaviour. The study is conducted in routine mental health services which enhances the generalisability of the study results to clinical practice.Trial registrationISRCTN96632579. Registered 1 May 2019. Retrospectively registered.

Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial.

Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.

Multidisciplinary intervention in the treatment of mixed anxiety and depression disorder

Depression and anxiety disorders are one of the main limiting psychopathologies in the world today. This pathology is linked to an inflammatory state and a dysregulation of both neurotransmitters and autonomic nervous system. Various treatments from psychiatric and psychological areas have shown different degrees of efficacy in their treatment, being Cognitive Behavioral Therapy one of the most successful. In addition, various interventions from other areas of knowledge are showing significant improvements in this pathology. This research aimed to analyze the psychological and physiological modifications of a multidisciplinary intervention that combines psychological treatment (Cognitive Behavioral Therapy), physical activity and nutritional intervention in a mixed anxiety and depression disorder (DSM-V). We analyzed modifications in the HAM-D depression, STAI anxiety questionnaire, subjective perceptions of anxiety, happiness, sleep and motivation and the autonomous modulation before and after a 6 multidisciplinary sessions of cognitive behavioral therapy, aerobic physical activity and nutritional intervention in a subject with a mixed anxiety and depression disorder. The results showed a reduction in the values of depression in HAM-D until the classification of non-depression, a reduction in both state and trait anxiety, an increase in the subjective perceptions of sleep, happiness and motivation and a greater parasympathetic modulation after the six intervention sessions. The combination of psychological therapy with aerobic physical activity and nutritional recommendations to treat mixed anxiety and depression disorder produced an increased parasympathetic tone and a decreased anxiety and depression symptoms in six sessions. This is a novel research that allows us to open the study of a new multidisciplinary field in the treatment of this disease that is highly present today.

Transcranial direct current stimulation and attention skills in burnout patients: a randomized blinded sham-controlled pilot study.

Background: Burnout is characterized by deficiencies in attention and several components of the working memory, of which the lingering effects of impaired attention and executive functions are the most frustrating. We hypothesized that anodal transcranial direct current stimulation (atDCS) over the left dorsolateral prefrontal cortex (DLPFC) can improve the executive control of attention and possibly several other components of working memory in patients with burnout. Methods: This was a randomized double-blind sham-controlled pilot study with two groups. Patients with burnout received three weeks of daily sessions (15 sessions in total) of atDCS or sham stimulation in addition to three weekly sessions of standard behavioral therapy. The primary outcome measure was attention and the central executive of the working memory. Secondary, the effect of atDCS was measured on other components of working memory, on burnout and depression scores, and on quality of life (QoL). Results: We enrolled and randomly assigned 16 patients to a sham or real stimulation group, 15 (7 sham, 8 real) were included in the analysis. atDCS had a significant impact on attention. Post-hoc comparisons also revealed a trend towards more improvement after real tDCS for inhibition and shifting, updating and control, and encoding. Both groups improved on burnout and depression scores. Conclusion: These data provide preliminary evidence for the value of atDCS over the left DLPFC in rehabilitating attention deficits, and possibly also central executive and encoding deficits, in burnout. However, the current study has some limitations, including the sample size and heterogeneous patient population. More elaborate studies are needed to elucidate the specific impact of atDCS over the left DLPFC on burnout. Trial registration: ISRCTN.com ( ISRCTN94275121) 17/11/19.

An Evaluation of Family-Based Treatment for OCD in Japan: A Pilot Randomized Controlled Trial.

Objective: Although family involvement in the treatment of obsessive-compulsive disorder (OCD) produces a reduction in OCD symptoms and has significant effects on global functioning, few studies have focused on family intervention as part of OCD treatment in Japan. This study aims to examine the feasibility and efficacy of the family-based exposure and response prevention (FERP) program for adult patients with OCD and their family members.Design: Randomized controlled pilot study.Methods: A total of 18 outpatients aged 18–65 years with a primary diagnosis of OCD and one family member of each patient were randomized to an intervention group or a control group (1:1). The intervention group received the FERP program, which consisted of 16 weekly face-to-face cognitive behavioral therapy (CBT) sessions, including eight joint sessions with family members, in addition to treatment-as-usual (TAU). The control group received TAU alone. The primary outcome was the alleviation of OCD symptoms, as measured by changes in the total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score from baseline to posttreatment. Analyses were provided on an intention-to-treat basis, and linear mixed models were used to test for significant group differences.Results: After 16 weeks, patients allocated to the FERP program showed improvement in OCD symptom severity, as measured by the total change score of the Y-BOCS (Hedges’ g = −1.58), as compared to the control group. Two patients (22.2%) in the FERP group reached remission, and five patients (55.6%) in the FERP group achieved treatment response. Clinical global improvement measured by the FAS-SR scores, K6 scores, and CGI-S scores was also observed (Hedges’ g = −1.35, −1.25, and −1.26, respectively) in the FERP group as compared to the control group. The dropout rate from the study was low (n = 2, 11.8%), and no adverse events were reported in the FERP group.Conclusion: Our results suggest that FERP may be an effective program for reducing patients’ OCD symptoms.Clinical Trial Registration: www.umin.ac.jp/ctr/, identifier UMIN000021763.

Effect of physical exercise intervention on mood and frontal alpha asymmetry in internet gaming disorder

PurposeWe aimed to evaluate the effect and neurophysiological mechanism of physical exercise intervention combined with cognitive behavioral therapy on mood and frontal alpha asymmetry in the treatment of Internet gaming disorder. MethodsFifty male adolescents with Internet gaming disorder were randomly assigned to one of two groups. In the cognitive behavioral therapy + physical exercise group (CBT + PE group, n = 25), participants underwent eight sessions of cognitive behavioral therapy and six sessions of exercise intervention; in the cognitive behavioral therapy-only group (CBT-only group, n = 25), participants underwent eight sessions of cognitive behavioral therapy and six sessions of supportive counseling. A resting quantitative electroencephalogram, Young Internet Addiction Scale, the Korean Attention Deficit Hyperactivity Disorder Rating Scale, Beck Depression Inventory, and Beck Anxiety Inventory were evaluated before and after the intervention. ResultsAlthough both the CBT + PE and CBT-only groups showed a significant reduction in Beck Depression Inventory and Young Internet Addiction Scale scores, indexing a decrease in depression, this effect was more pronounced in the CBT + PE group than in the CBT-only group. An increase in the F4–F3 and F8–F7 frontal alpha asymmetry values was more pronounced in the CBT + PE group than in the CBT-only group. ConclusionPhysical exercise intervention in combination with cognitive behavioral therapy for individuals with Internet gaming disorder seems to improve the severity of internet use and depressive mood and enhance left prefrontal activation.

The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents

Objective: Associations between dysphonia and paradoxical vocal fold motion (PVFM) have been previously reported in adults, but it is unclear whether similar associations exist for adolescents. The goals of this study were to identify the prevalence and severity of voice disorders in adolescent patients with PVFM, identify differences between those with and without clinician-identified dysphonia, and investigate what factors were associated with voice handicap in this population. Methods: A retrospective review of eligible adolescent patients diagnosed with PVFM over a 1-year period at a single institution was undertaken. Data collected from the medical record included demographic background, medical history and workup, patient- and family-reported symptoms, and findings from the laryngeal examination. The presence or absence of clinician-diagnosed dysphonia was used to subdivide the sample for analysis. Results: Forty-eight patients with PVFM were included. The sample was primarily female (73%) with a median age of 15 years. Few patients had voice complaints (5%), but clinician-diagnosed dysphonia was common (52%) and ranged from mild to moderate. Vocal hyperfunction was frequently observed (55%), but anatomic abnormalities associated with dysphonia were rare (6%). Adolescents with dysphonia were significantly older, more likely to have vocal hyperfunction on laryngoscopy, and more likely to return for therapy than those without dysphonia. No notable differences existed in the number of behavioral therapy sessions or in the likelihood of completing treatment between the two groups. The majority of participants (79%) had at least one “confounding factor” (i.e., were currently taking a medication for asthma, allergies, or reflux, or had a laryngeal abnormality) but this did not differ significantly between those with and without dysphonia. A minority of individuals (28%) had abnormal scores on the Voice Handicap Index (VHI). Age was positively correlated with dysphonia severity but no other significant associations were observed. Conclusion: Although voice complaints are rare, dysphonia among adolescents with PVFM is common and can occur in the absence of laryngeal abnormalities and medical comorbidities, typically as a result of vocal hyperfunction. Dysphonia does not appear to be a barrier to PVFM treatment and may be a useful target in therapy.

The Role of Parental Knowledge and Attitudes about ADHD and Perceptions of Treatment Response in the Treatment Utilization of Families of Children with ADHD

ABSTRACTThe present study examined the impact of parental knowledge and attitudes about attention-deficit/hyperactivity disorder (ADHD), and parental perceptions of treatment response on the utilization of behavioral and pharmacological ADHD treatments, using data from a longitudinal treatment study designed to assess physical growth in children with ADHD. It also explored if these relations were moderated by race/ethnicity. Participants include 230 (74% Hispanic) families of treatment naïve children with ADHD (M age = 7.56, SD = 1.94; 73% male). Families were randomly assigned to receive behavior therapy (BT) or stimulant medication (MED; which also included low dose BT). After 6 months, families whose children still showed at least moderate impairment had access to either treatment for a total of 30 months. Utilization was measured using the number of BT sessions attended and total mg of MED taken over the study period. Families who reported more willingness to use medication for their child’s ADHD at baseline were more likely to use MED and less likely to use BT, regardless of race/ethnicity. Parental knowledge about ADHD was only important in predicting BT utilization for White non-Hispanic families. Greater reduction in ADHD symptoms and impairment significantly predicted more MED utilization for Hispanic families. Results highlight the need to explore multiple parent (e.g., medication willingness) and child (e.g., symptom severity) factors when considering treatment utilization. Results also highlight ethnic differences in which factors affect treatment utilization.

Applied muscle tension and exposure during the cognitive behavioral therapy of a adolescent with blood- injection -injury phobia: a case report

Blood-injection-injury phobia (BII) is a specific type of phobia that includes anxiety and avoidance behaviors against blood, injection, injuries or medical practices. Children and adolescents are seen with a frequency of 0.8% to 1.5% and the median age of onset is 5.5. It has been shown to have some unique factors (fainting, disgust, physiological symptoms, and pain) compared to other phobia subspecies. The increase in heart rate and blood pressure follows a sudden decrease, and this condition is called vasovagal syncope. Cognitive Behavioral Therapy (CBT) is one of the most effective treatment methods in BII. CBT can be applied for one session or 8-12 sessions. CBT includes psychoeducation, automatical thoughts detection and restructuring, prevention of exposure and avoidance. Blood pressure increasing techniques, especially applied muscle tension technique, to prevent syncope during exposure, increase the effectiveness of therapy. In this case report, the treatment process of adolescent patient admitted with blood-injection-injury phobia successfully completed using CBT techniques will be discussed. After ten sessions of cognitive behavioral therapy, the patient's blood concerns and avoidance behaviors were completely gone. He managed to give blood, which he stated the highest degree of discomfort in the hierarchy of fear, without experiencing syncope. It has been demonstrated with the fact that CBT, which involves exposure, especially in combination with blood pressure raising techniques, is effective in the treatment of BII in children and adolescents, as in adults.

Feasibility of one-session treatment for specific needle phobia in an adult IAPT service – a case series

AbstractOne-session treatment for specific phobias (OST; Öst, 2012) has been found to be efficient and effective in reducing the severity of phobia in an adult population. This study aimed to investigate the feasibility of OST in an Improving Access to Psychological Therapy (IAPT) primary care service in the North East of England. Participants were four women and one man between the ages of 21 and 46 years; all presented with needle phobia. Treatment consisted of three clinical contacts: a 1-hour pre-treatment interview to identify the catastrophic belief centred on the phobic situation; a 2.5–3-hour treatment session using exposurein vivo(i.e. images, videos and handling of a syringe – no actual injections) and participant modelling in accordance with OST protocol; and a 30-minute follow-up telephone appointment. Outcome was measured with standard IAPT and additional psychometrics, as well as qualitative client feedback. The outcome suggests the application of OST to be effective for needle phobia, as well as feasible and cost- and resource-efficient in its application to an IAPT primary care service. Further research needs to investigate its effects in comparison with multiple single sessions of cognitive behavioural therapy in an adult population, as well as appropriate outcome measures to suit an IAPT application.Key learning aims(1)To gain a basic understanding of one-session treatment for specific phobias (OST).(2)To enhance understanding of the implications of OST in an IAPT primary care service.(3)To acquire useful information about practicalities and challenges of OST in an IAPT primary care setting.

Augmentation of Positive Valence System–Focused Cognitive Behavioral Therapy by Inaudible High-Frequency Sounds for Anhedonia

Recent conceptualizations in Research Domain Criteria have indicated that anhedonia, 1 of 2 core symptoms of depression, which can be treatment resistant, is associated with deficits in the positive valence system, and inaudible high-frequency sound therapy has been shown to enhance reward-related brain circuitry. Hence, cognitive behavioral therapy focusing on the positive valence system enhanced with sound therapy could have a synergistic effect on anhedonia. To test the augmentation effect of inaudible high-frequency sounds on the efficacy of positive valence system-focused cognitive behavioral therapy to treat anhedonia. In this individual-level allocation, exploratory, single-center randomized superiority pilot trial, patients, therapists, and evaluators will be masked to intervention or placebo assignment. The trial will take place at a national psychiatric referral hospital in Tokyo, Japan, among 44 adult patients with clinically significant anhedonia and moderate to severe depression. Outcomes will be analyzed following the intent-to-treat principle using a repeated-measures mixed model. The intervention group will participate in 8 weekly sessions of positive valence system-focused cognitive behavioral therapy with in-session exposure to an inaudible high-frequency sound; the comparison group will undergo cognitive behavioral therapy with in-session exposure to a placebo sound. The primary outcome is anhedonia assessed using the self-reported Snaith-Hamilton Pleasure Scale. The secondary outcome is anhedonia assessed using the clinician-administered version of the Snaith-Hamilton Pleasure Scale. Recruitment for this study began in May 2018, and the projected date of final allocation is January 2020. A total of 21 eligible patients were registered for participation as of May 30, 2019. To date, treatments for depression do not guarantee clinically successful outcomes. This pilot trial will provide preliminary evidence of the augmentation effect of high-frequency inaudible sounds on cognitive behavioral therapy for anhedonia. Overall, exposure to an inaudible high-frequency sounds does not require attentional or cognitive effort from either patients or therapists; therefore, results from a future confirmative trial could indicate that cognitive behavioral therapy can be augmented in an effortless manner. umin.ac.jp/ctr Identifier: UMIN000031948.

Manualized cognitive behavioral group therapy to treat vasomotor symptoms for women diagnosed with mood disorders

ObjectiveThis 6-week, prospective, single-arm study examined the feasibility, acceptability, and preliminary efficacy of cognitive behavioral group therapy in peri- and postmenopausal women with mood disorders (major depression or bipolar) and problematic vasomotor menopausal symptoms. Methods59 participants from an outpatient clinic with mood disorders and problematic vasomotor symptoms were enrolled. The primary outcomes were change from baseline to 6 weeks in Hot Flush Night Sweat Problem Rating, Hot Flash Related Daily Interference, and Quality of Life. Secondary outcomes were change in Hot Flush Frequency, depression, anxiety, perceived stress, anhedonia, beliefs and cognitive appraisals of menopause. ClinicalTrials.gov [identifier: NCT02860910]. ResultsOn the Hot Flush Night Sweat Problem Rating, 39.3% improved 2 or more points, which was clinically relevant. Changes in Quality of Life (p = .001) and the Hot Flash Related Daily Interference Scale were also significant (p < .001). Significant results were found on most secondary outcomes (hot flush frequency on the Hot Flush Daily Diary, depression, anxiety, perceived stress (p < .001) and anhedonia (p = .001). One of six subscales (control subscale) on the cognitive appraisal of menopause significantly improved (p < .001). Three subscales on the beliefs measure did not change significantly (p = .05, p = .91, and p = .14). Six-week study retention was robust (N = 55, 93%) and 94.2% of individuals reported that cognitive behavioral group therapy sessions were useful. ConclusionThis exploratory study suggests that CBGT is acceptable, feasible, and efficacious in women with mood disorders and problematic menopause vasomotor symptoms. Further studies are needed using more rigorous and controlled methods.

Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults.

Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39-0.42, p < 0.03-0.04) at the 6-month follow-up. Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.

Racial/Ethnic Differences in Physiological Stress and Relapse among Treatment Seeking Tobacco Smokers.

Stress is robustly associated with tobacco smoking and relapse. African Americans experience greater difficulty quitting compared to whites, yet no studies have examined race differences in physiological stress biomarkers during a quit attempt. This pilot study compared cortisol levels among treatment-seeking African American and white smokers, and relapse rates. Adult smokers (N = 115; n = 72 African American, n = 43 White) received eight sessions of group cognitive behavioral therapy plus transdermal nicotine patches. Assessments included demographics, salivary cortisol (collected at session 1, the end-of-therapy [EOT], and one-month post-therapy), and carbon monoxide-verified smoking relapse. Overall, cortisol levels declined over the course of the day at baseline, the EOT, and the one-month follow-up. African Americans exhibited lower cortisol levels compared to Whites at baseline and the EOT, but not at the one-month follow-up. In addition, African American smokers exhibited flatter slopes compared to Whites at each time point. Relapse rates were greater among African Americans at the EOT and one-month follow-up. The attenuated cortisol pattern observed in African Americans may indicate hypothalamic-pituitary-adrenal axis (HPA) exhaustion and aid our understanding of tobacco-related disparities. There is a need to focus on stress mechanisms and specific intervention approaches in order to eliminate racial/ethnic differences.

Quantifying the Association Between Psychotherapy Content and Clinical Outcomes Using Deep Learning

Compared with the treatment of physical conditions, the quality of care of mental health disorders remains poor and the rate of improvement in treatment is slow, a primary reason being the lack of objective and systematic methods for measuring the delivery of psychotherapy. To use a deep learning model applied to a large-scale clinical data set of cognitive behavioral therapy (CBT) session transcripts to generate a quantifiable measure of treatment delivered and to determine the association between the quantity of each aspect of therapy delivered and clinical outcomes. All data were obtained from patients receiving internet-enabled CBT for the treatment of a mental health disorder between June 2012 and March 2018 in England. Cognitive behavioral therapy was delivered in a secure online therapy room via instant synchronous messaging. The initial sample comprised a total of 17 572 patients (90 934 therapy session transcripts). Patients self-referred or were referred by a primary health care worker directly to the service. All patients received National Institute for Heath and Care Excellence-approved disorder-specific CBT treatment protocols delivered by a qualified CBT therapist. Clinical outcomes were measured in terms of reliable improvement in patient symptoms and treatment engagement. Reliable improvement was calculated based on 2 severity measures: Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7), corresponding to depressive and anxiety symptoms respectively, completed by the patient at initial assessment and before every therapy session (see eMethods in the Supplement for details). Treatment sessions from a total of 14 899 patients (10 882 women) aged between 18 and 94 years (median age, 34.8 years) were included in the final analysis. We trained a deep learning model to automatically categorize therapist utterances into 1 or more of 24 feature categories. The trained model was applied to our data set to obtain quantifiable measures of each feature of treatment delivered. A logistic regression revealed that increased quantities of a number of session features, including change methods (cognitive and behavioral techniques used in CBT), were associated with greater odds of reliable improvement in patient symptoms (odds ratio, 1.11; 95% CI, 1.06-1.17) and patient engagement (odds ratio, 1.20, 95% CI, 1.12-1.27). The quantity of nontherapy-related content was associated with reduced odds of symptom improvement (odds ratio, 0.89; 95% CI, 0.85-0.92) and patient engagement (odds ratio, 0.88, 95% CI, 0.84-0.92). This work demonstrates an association between clinical outcomes in psychotherapy and the content of therapist utterances. These findings support the principle that CBT change methods help produce improvements in patients' presenting symptoms. The application of deep learning to large clinical data sets can provide valuable insights into psychotherapy, informing the development of new treatments and helping standardize clinical practice.

Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial

To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages. Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care. Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019. English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction. Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care. Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0). Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention. PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.

Management of chronic fatigue syndrome/myalgic encephalomyelitis in a pediatric population: A scoping review.

Chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) negatively impacts the quality of life for children with the condition. Although up to 2% of children have CFS/ME, the bulk of research investigates adults with CFS/ME. Using the PRISMA extension for a scoping review and the work of Arksey and O’Malley (2005), a scoping review was conducted of all relevant peer-reviewed research investigating nutrition, exercise, and psychosocial factors within a pediatric population diagnosed with CFS/ME. Key themes found were nutrition and dietary components, exercise therapy, psychosocial factors, and multifaceted treatment. Nutrition was explored on its own as a tool to decrease symptoms; however, there were very few studies found to examine nutritional deficiency or treatment with those under the age of 18. Graded exercise and resistance training improved fatigue severity and symptoms of depression in adolescents with CFS/ME. Research exploring psychosocial factors of CFS/ME presented attributes that could lead to being diagnosed as well as barriers to treatment. The multifaceted treatment undertaken typically consists of graded activities/exercise, cognitive behavioral therapy, nutritional advice, and family sessions. This has shown to increase school attendance and decrease the severity of the fatigue for adolescents. Minimal literature exploring CFS/ME within a prepubescent population presents the need for further research.

Pretreatment cortisol predicts trauma-focused psychotherapy response in youth with (partial) posttraumatic stress disorder

BackgroundDespite availability of effective trauma-focused psychotherapies, treatment non-response in youth with (partial) posttraumatic stress disorder remains substantial. Studies in adult PTSD have suggested that cortisol is associated with treatment outcome. Furthermore, cortisol prior to treatment could be used to predict treatment success. However, there is a lack of comparable studies in youth with (partial) PTSD. The objective of the current study was therefore to test whether cortisol prior to treatment would differ between treatment responders and non-responders and would positively predict the extent of clinical improvement in youth with (partial) PTSD. MethodsYouth aged 8–18 with PTSD (79.2%) or partial PTSD (20.8%) were treated with 8 sessions of either trauma-focused cognitive behavioral therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Prior to treatment initiation, salivary cortisol was measured in treatment responders (n = 23) and treatment non-responders (n = 30) at 10 and 1 min before and 10, 20 and 30 min after personalized trauma script driven imagery (SDI). The cortisol stress response (>1.5 nmol/L increase from baseline) and basal cortisol secretion was assessed during the SDI procedure. We hypothesized that treatment responders would display higher cortisol levels caused by increased cortisol reactivity prior to trauma-focused psychotherapy relative to psychotherapy non-responders and higher cortisol levels would positively predict the extent of clinical improvement. ResultsScript driven imagery did not induce a cortisol stress response in all but two participants. Prior to treatment responders showed significantly higher basal cortisol secretion during SDI compared to treatment non-responders. This effect remained significant after controlling for gender. Higher pre-treatment basal cortisol secretion further positively predicted the extent of clinical improvement during trauma-focused psychotherapy. ConclusionBecause SDI failed to provoke a cortisol stress response in our sample, the question if cortisol reactivity differs between treatment responders and non-responders remains inconclusive. However, our results do suggest that higher pretreatment basal cortisol secretion forms a potential indicator of prospective trauma-focused psychotherapy response in youth with (partial) PTSD. Although, the amount of uniquely explained variance in clinical improvement by pre-treatment cortisol secretion is limited and still renders insufficient basis for clinical applicability, these findings do suggest directions for future studies to delineate the mechanisms of treatment success in youth with (partial) PTSD

73-LB: Improvements in Sleep Quality after Cognitive Behavioral Therapy for Insomnia Are Associated with Improved 2-Hour Post-Load Glucose

Poor-quality sleep may be a possible modifiable risk factor in the development of T2DM. We conducted a pilot clinical trial (N=17) to examine the effects of insomnia treatment on insulin resistance in persons with prediabetes. Participants received up to 7 sessions of cognitive behavioral therapy for insomnia (CBT-I), a highly effective, first-line treatment for insomnia. Before and after CBT-I, participants underwent 75-gram oral glucose load test and wore wrist Actiwatches (ActiGraph GT9X Link) to measure sleep indices. Actigraphy data were collected, including wake after sleep onset (WASO; length of periods of wakefulness after sleep onset) and sleep efficiency (SE; ratio of time asleep to time in bed). We calculated the correlation between change in 2-hour post-load glucose and change in WASO and SE in those who completed treatment (at least 6 sessions of CBT-I; N=13). Decreases in WASO and increases in SE after CBT-I (indicating improved sleep) were associated with decreased 2-hour post load glucose levels (see Figure). The estimated Pearson correlations indicated medium-large effect sizes per Cohen’s rule, suggesting a potential reduction in the risk of full T2DM. This small pilot study shows the need for further research on whether treatment of insomnia improves glucose tolerance. Disclosure E.S. LeBlanc: None. N. Smith: None. M. Allison: None. G. Clarke: None. Funding Kaiser Permanente